For those who are unaware, CRPS stands for “Complex regional pain syndrome (CRPS)”. CRPS usually affects sensory and motor disturbances of one’s limbs.
However; as a crucial aspect of the nervous system, our eyes also become affected by the disturbances of CRPS. Complex regional pain syndrome does not have a clear definition by doctors thereby making diagnosis that much more difficult.
Those who suffer from CRPS describe development of the disease as occurring in the face and after a traumatic encounter. For example, surgery trauma to the face, having a tooth pulled, or having a lesion.
CRPS spreads by traveling through the nervous system. Given the easy flow of pathways to all organs, traveling by way of the nervous system allows those who have CRPS in the head and face to develop and feel the disease’s crippling effects.
Traveling along the nervous system allows CRPS to access different areas of the body and create damage. There are two instances of CRPS, detailed as CRPS I and CRPS II.
Given that the disease has many pathophysiologic sensations and effects, different symptoms align with each category.
Incidence of CRPS I comprises 90% of all cases of CRPS. The pathophysiologic mechanism of CRPS is multi-factorial and includes:
- Peripheral and central sensitization
- Inflammatory changes
- Altered sympathetic function
- Changes in the somatosensory cortex
- Genetic and psycho physiologic interactions
- Intermittent or persistent pain as a burning sensation
Clinical methods to diagnosis CRPS I are:
- History of trivial injury
- Persistent peribulbar pain with occasional burning character
- Cutaneous hyperalgesia even after healing of primary pathology
- Recurrent oedema of eye lids
- Non-detection of obvious cause for the pain
- Increased moisture of skin during episode of oedema
- A favorable response to gabapentin
When the disease of CRPS I is travelling anteriorly, the sympathetic nerves in the facial area that supply eyelid muscles, skin of forehead and by following ophthalmic artery also regulate blood flow to ocular and orbital regions.
The irregular amount of afferent sympathetic nerves around the spinal dorsal root ganglion is the center for maintaining pain in chronic pain conditions in other regions of body.
This issue of nerves in the facial and eye area highlight the ease of which CRPS can travel and access the ophthalmic areas via blood lines.
Reducing the sympathetic flow in the early stages of CRPS, can aid in the early intervention techniques of reducing CRPS afflictions to the eye.
Early intervention is essential in preventing regulation and expression of adrenergic receptors on nociceptive fibers of the eye.
CRPS literature does not have much information to offer readers on the effects of the disease on the head and face. Individuals claim headaches for those with CRPS in the head and face are throbbing and excruciating with very little by way of relief methods.
Occasional medication may help a bit, but the headaches never truly stop and offer the CRPS sufferer relief. The headaches are so intense that daily routines become inhibited and quality of life can diminish.
With headaches, those suffering from CRPS may deal with extreme bolts of pain and burning in the face, head, and neck. The extreme pain is excruciating and leads to difficulty eating and drinking as usual.
For some of those who suffer, pain may only affect one side of the face. The pain is a burning sensation deep within the cheekbone and eye areas. The face may also become discolored or reddened as CRPS takes hold.
Those who have headaches and extreme pain in the face may also have difficulty chewing since so many facial muscles are utilized for this simple task.
Muscle spasms occur from the act of chewing which may trigger the throat and neck area to also spasm. These spasms can occur spontaneously and trigger choking.
A man suffering from CRPS was examined with complaints of deep seated pain with cutaneous swelling and discomfort over left eye. The man suffered a trivial swipe injury in the same eye from the tail of a cow.
The initial symptoms of redness and lacrimation were significantly reduced with the local eye drops given and the initial injury subsided. After two months, the man began to have deep seated orbital pain along with swelling and burning sensations around the eye.
The man in question took 100 mg medicine twice per day for one week. After his next exam, the man continued to have persistent pain, developed moist skin over his left eye lid and minimal resolving oedema over left eye lids.
When increasing his medicine dosage to 300 mg thrice a day for four weeks, he described the pain and edema had improved in one week and he was pain free in three weeks.
CRPS affects the eyes in many ways but vary between patients. Determining the initial state of the eye, and then the type of injury to the eye, may help determine the full affect one may have after developing CRPS.
Medications alter one’s ability to find comfort and functioning of the eye and a specialized treatment plan should be in place for each patient’s unique circumstance.
The main goal of the therapy is to relieve pain, improve function and provide psychological support to those afflicted with CRPS of the eye.
Nonsteroidal anti-inflammatory drugs have been partially helpful due to the control the drugs offer to the peripheral component of the pain due to inflammation.
Along with therapy, early aggressive management of CRPS has been described to produce excellent results. Delaying treatment can be debilitating and disabling.
A mechanism-based approach and better understanding of its pathophysiology may eventually lead the pathway to successful management.
Preventing CRPS may be considered to be an early aggressive treatment of CRPS given that prevention is often the best medicine for any infliction.
Vitamin C is linked to prevention of CRPS and with the prevention can come a cure. A link to an article describing the awesome effects of Vitamin C in regards to CRPS may be found here:
Resources
www.rsdhope.org/crps-in-the-head-and-face.html
neurotalk.psychcentral.com/showthread.php?t=184862
www.ncbi.nlm.nih.gov
